Greg BlassTo fight the heroin epidemic, we must get smarter about prescription opioids

Is it fair to hold the medical profession responsible, at least in part, for the heroin epidemic? We’re not talking of the health care providers who have yielded to the evil of criminal greed. Our focus here is rather on the routine, well-intentioned but lax prescription practices for painkillers, specifically opioids, carried out far and wide for decades.

Heroin, the hooded, grim reaper of death, kills at an ever-increasing rate, bringing a terrible end to young lives often so full of promise. As its scourge drags on, oddly there’s less concern with the painkillers that are constantly heroin addiction’s foundation. To understand this widespread acceptance, if not cultural embrace, of painkillers, particularly opioid analgesics, such as codeine and oxycodone, we should reflect on how opioids find their way into our lives. Some critique, and some solutions, might well be in order. One need not be a medical doctor, nurse practitioner or health care expert to share these thoughts. Actually, juries of laypersons by law decide complex, medical malpractice issues here and worldwide.

Opioid prescriptions became popular among medical practitioners in the 1980s, a popularity that quickly became a rampage. This followed the FDA’s initial approval of opioids for the public during an era marked by that agency’s over-eager policy to please the drug manufacturers and chemical companies (witness the FDA’s careless approval of the artificial sweetener, Aspartame). For decades thereafter, medical schools taught their students little, if anything, about the risks of opioids.

There continues widespread imprudent prescriptions for opioids, with poor education for patients of opioids’ effects. A dangerous gap is found in many health care providers’ inadequate instructions about the safe use of prescribed opioids and how to dispose of the frequently leftover painkillers, as well as their proper storage.

It’s something akin to the hasty, and in hindsight, excessive prescriptions for antibiotics. In that situation, overprescription has all to do with the emergence of dangerous, disabling, super bacteria, resistant to antibiotics altogether. Yet according to the Centers for Disease Control and Prevention, in a recently released study, antibiotics are prescribed in hospitals alone three times more often than medically necessary.

Drug overdose deaths, however, as per the CDC, hit our communities in increased numbers every year since 1999, and prescription drug medications, alone or in combination with others, are involved in a majority of them. In 2010, the last date for which comprehensive data are available, there were 38,329 deaths from overdose, nearly 60 percent of which (22,134) involved prescription drugs. Three quarters of these (16,651) involved opiod painkillers. Updated numbers are not yet available, but the trends, according to the CDC, are spiking dramatically.

An alarmingly potent drug, opioids, with remarkable ease, cause “opioid tolerance” when taken orally in 30mg doses daily for merely one week, according to a 2011 Public Policy Statement of the American Society of Addiction Medicine. When one is “opioid tolerant,” a withdrawal syndrome is LIKELY to occur when drug use stops. Symptoms of opioid withdrawal include sweating, shaking, nausea, vomiting and irritability. At this stage it’s vital to seek professional help.

Too many patients on prescribed opioids become dependent, and often continue use for their own reasons, such as the better sleep they get, or the suddenly unexpected relief from other pain, or taking one before a workout at the gym for better intensity, and so on. All too soon, their dependence takes a cruel dive into a relapsing, chronic brain disease.

One would expect that one’s opioid prescription would run out, and for those who experience that, what almost invariably fills in is cheap, potent, widely available and deadly heroin. But the villainous opioids are widely available, too. How? Let’s start with the major way: Initially, opioids will find their path into a patient’s treatment for pain as a valuable resource that allows postoperative activities essential to recovery. A survey of urology patients showed that 58% of their prescribed opioids were consumed, and almost all simply kept the rest at home because the patients thought they might be useful again.

Along with better scrutiny by health caregivers, opioids will be far less available and less dangerous with some simple steps by our North Fork businesses and patients:

When a prescribed dose is finished, mix remaining opiods with an unpalatable material, such as kitty litter or used coffee grinds, in a sealed plastic bag, and dispose of in the trash; but never, as strongly urged by the EPA, down the toilet. This mixing and bagging, FDA-prescribed disposal method greatly reduces the chances that someone will find and take them or that a child or pet will ingest them. In fact, exposure to improper meds is rising dramatically among children under seven years old, the FDA reports.

Take advantage of local disposal programs, such as at police departments, for unused opioids. King Kullen food markets, in a praiseworthy public service, has been accepting unused opiods. Other chain stores ought to follow suit.

Hospitals must do a far better job of educating surgery patients before they are discharged. Any discharge plan must clearly inform the opioid patient on use, risk, storage and disposal and how to contact the prescriber. There is much room for improvement here.

Opioid prescribers have to intensify screening of patients before any suggestion of taking these painkillers. The CDC reported last year that opioid addiction and other disorders are a significant risk for people who already have a history of alcohol or drug use, mental illness, a low income, even living in a rural area. Depression and opioids pose a deadly combination. Any of these background factors deserve red flag status.

There’s more – much more – to do about opioids. Doctors and patients alike have to give this incredibly powerful agent all the skepticism, respect, and fear it deserves. Its thunderous impact on too many lives demands rethinking and action. Best to admit as well – there’s a lot we still don’t know. When we know that we don’t know what we don’t know, that’s true knowledge, and with opioids, it’s enlightenment.

Greg Blass has spent his life in public service since he enlisted in the U.S. Navy as a teenager. He has worked in the private sector as an attorney and served six terms representing the East End in the Suffolk County Legislature, where he was also presiding officer. Greg has worked as an adjunct professor at Suffolk County Community College, as Greenport village attorney, as N.Y. State family court judge and as Suffolk County social services commissioner. Now retired, Greg is active in volunteer work and is a member of the board of directors of several charities. A resident of Jamesport, he and his wife Barbara have two grown children.

Greg has spent his life in public service since he enlisted in the U.S. Navy as a teenager. He is a former Suffolk County Family Court judge, six-term Suffolk County legislator and commissioner of Social Services. Now retired, Greg is active in volunteer work and is a board member of several charities. He lives in Jamesport.
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